Loading...
HomeMy WebLinkAboutBuilding Permit #1295-2016 - 559 JOHNSON STREET 6/10/2016 BUILDING PERMIT N%.F.D o��T LEU ,b qh0 TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION Permit No#: i (p Date Received / gSSACHU`��� Date Issued: J114 I ORTANT: Applicant must complete all items on this page LOCATION ffc,5 9 6t Print PROPERTY OWNER PGL) C1x I( 15—;L Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family El Industrial ❑ Alteration No. of units: ❑ Commercial A Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ff Wetlands ❑ Watershed District ❑Water/Sewer } DESCRIPTION OF WORK TO BE PERFORMED: d S`��'� `� �ve Wt�ec►�-c� 5�@!" c �� �?� fs'Y�� p C' J�t 1 w ��S tl e-V.) rz r Ji4jr Identificati n- Please Type or Print Clearly OWNER: Name: ( r e _ Phone: Address: 9 55 o �t`5J`~' If Contractor Name: �C'�' a� Phone: Email: 54. E?.-, �X-7 ' a�� `, ,r c Address: P0 ti. Supervisor's Construction License: C5— ?C 6 9 Exp. Date: Home Improvement License. /d g3 7J _Exp. Date: ARCHITECT/ENGINEER Phone: y Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (n /Q FEE: $ +5 Check No.: I / Receipt No.: �U NOTE: Persons contracting with unregistered contractors do not have access to the r d Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swumning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments ti ,y Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FLRE4DEPARAT MENT - TY m rnpster,o;n site; ,yes i, E Locatedtaf+124�MainSf�eet� �� Fire EDepartment signature /date. `0DMMENr ,S Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application �. Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) :> Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording M ust be submitted with the building application Doe:Building Permit Revised 2014 Location No.J G j �- 7 0 Date to I oil . - TOWN OF NORTH ANDOVER 4• H Certificate of Occupancy $ Building/Frame Permit Fee _ Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ _ p. Check# V- - ;; �`r Building Inspector OO R T1i Town of )3� _. : : ., Andover O y .00-001, No. * _ I z h ver, Mass , JLAJCG, 1012b 40 cocMicNew�cK �1• A04A T E D I"!? C) S V BOARD OF HEALTH Food/Kitchen PER T T LD II Septic System THIS CERTIFIES THAT ... .............I.... .0 1 1a�'.Ct..... . ,,,,,, ,, ................... BUILDING INSPECTOR %0A ` Foundation has permission to erect .......................... buildings on . ~ l � � Rough to be occupied as ..�.�"5�... \ ...... . ...1b..oLrefc.4.b:`. ...�� L IIS Chimney provided that the person accepting this permit shall in evely respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST110 T Rough Service .. ................ .. .............. Final BUILDIN IN PECTOR ' GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 1tw const won Co;, NFMC70ELIfi(: SPECIALISTS KeenConstructionCo.com Calzetta, Paul 559 Johnson St. N.Andover, MA 01845 978-686-3520 Contract#5780;Appendix A May 15, 2016 Kitchen work: • Remove existing range hood,trim,counter back splash and cabinet valance • Supply&install%" blueboard and skimcoat plaster to smooth finish on all walls in kitchen • Re-install range hood • Remove and replace baseboard heat enclosures • Supply& install trim on crown, doors,windows and base in kitchen • Supply& install new cabinet hardware Front window trim: • Remove and dispose of existing window trim of living room front window • Supply& install new trim to match existing Total Price: $3610(three thousand six hundred ten dollars) Price does not include cost of permits, painting or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this contract. Payment Schedule:$1000 due upon signing contract $1500 due when plaster is complete $1110 due at completion of work Cus Robert Keen �3 l Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 KEEN CONSTRUCTION CO. PROPOSAL ° 1175 TURNPIKE STREET NORTH ANDOVER,MA 01845 All home improvement contractors and subcontractors Tel: (978)691-5201 engaged in home improvement contracting, unless Fax:(978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered SubmittedYJ �� ��. with the Commonwealth of Massachusetts. Inquiries To: f c J , ` about registration and status should be made to the l {_ Director,Home Improvement Contract Registration,10 k o x�'7 \ Park Plaza, Room 5170, Boston, MA 02116 617.973- A A 8787 Owners who secure their own construction �c �� A �i 17,14 5 related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. P41DNE�„- r DATE REGISTRATION NO. EIN N0. 1)�7`�' 6 .'"' ✓` 2- S/�� (�� MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install ❑ See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: > Construction related permits: ---_..._.__________........._........_..._.._..............._.._......._.._—_...... _......_............_.....................................................................................__.................................._....._.........__........................._._............................................_......................__._............._ WC RK SCF / Contracyr wwffll not in the work or order the materials before the third day following the signing of this Agreement,unless specified her rf `rtgl �gntractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractors control,the work will be completed by d / t!>(dale). The Owner hereby acknowle gas agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not Ile considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship fora period of �^ following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contract ,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied. repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of D' L V i i;r J 4 Si Y. �L,'�,J iC.(1 E t 1 -dollars($ 3C t Q, , QC ). Payment to be made as follows: /e ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant /e ($ ) upon completion 1175 TURNPIKE ST. 1 of Street Address ),info o(e leo + . N. ANDOVER, MA 01845 __ ------ City/State II be made forthwith upon (978 691-5201 (978)682-3231 o pletion of work under this contract. Phone Fax Notice: No agreement for home improvement contracting work shall require a >down payment(advance deposit)of more than one-third of the total contract price Name of Sa esr u) or the total amount of all deposits or payments which the contractormust make,in —� advance,to order and/or otherwise obtain delivery of special order materials and nvth ze0 e equipment,whichever amount is greater. Note:This proposal may he withdrawn by us it not aaeptetl within days. Acceptance Of Proposal-I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Cancellation must be done in writing. DO NOT,SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature ��-^^�'� '� {''r`!-- "� Date Signature Date `� 1 IMPORTANT INFORMATION ON BACK► The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): e V\ '1 Address: -7 G'$P one#: 973—(fr 57zC) 1 City/State/Zip: y Are you an employer?Check the appropriate box: Type of project(required); 1.M I am a employer with 2- employees(full and/or part-time).* 7. New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12-F1 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance? 14.0 Other 6.0 We are a corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ����v� ���5 �pi-5 / Policy#or Self-ins.Lic.#:6 14 U B ,-9/9 1 N5-?, Z �� Expiration Date: L� 1C� Job Site Address: gp Y���j�✓1 �'j` City/State/Zip: r r )�©�S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify n er 1 p z s and penalties of perjury that the information provided above is true and correct. (a h� Signature- Date: Phone#: 69/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACCM0 CERTIFICATE OF LIABILITY INSURANCE DATE(MWDONYYY) II F10/23/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CANTE.CT Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 aIc o:(781)942-2226 137 Main Street ADDRESS:bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk & Dedham Insurance 23965 INSURED JNSURER B:SafetY Insurance Co an 39454 Keen Construction Company INSURERC.Travelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERCL1552101779 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND.CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEPOLICY EFF POLICY EXP LTR POLICY NUMBER M LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 7 OCCUR PREMI ES a currence 3 100,000 LID-P-010078/000 3/13/2015 3/13/2016 'MED EXP(Any one rson) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICYO JECTT LOC PRODUCTS-CCMP/OP AGO $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY E I as Idenl $ 1,000,000 B ANY AUTO BODILY INJURY('er person) $ ALL OWNEDSCHEDULED AUTOS X AUTOS 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Peraccldent) $ X HIRED AUTOS X NAUTOtO ED PROPERTYDAMAGE $ Underinsured motorist $ 100,000 UMBRELLA LIAR OCCUR EACHOCCURRENCE g EXCESS LUIB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TU F ANY PROPRIEfOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? aNIA $ 100 000 C (Mandatory In NN) 6HUB-999IM58-2-15 10/0/2015 10/8/2016 E.L.DISEASE-EA EMPLOYE $ 100,000 8 eb,deaaibe under DESCRIPTION OF OPERATIONS bebw El.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddWonst Ramarks Sehoduts,may be attaclwd If mora space Is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tows] of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2oud1) i Massachusetts-Department of Public Safety Board of Building Regulations and Standards ConstrUCiltB.'Supervi50r License: CS-076691 'ITS ROBERT A KEElY 12 E WATER ST, R North Andover 0 954--�� �Jr,Q` Expiration Commissioner 08/16/2017 �ie (On-rtvrrtarn�ueu.�l�a��cca�ac�iscaeCYi ice of Consumer AAff�airs&Business Regulation x E IMPROVE T CONTRACTOR e91stratIon:,,_ Type }Q 83= Expirati¢�._ x9 ; r:.� _ �-� Supplement Car ,., f;...�._: , KEEN CONSTRUCTI31 , ROBERT KEENcr 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary